MP6-04 THE IMPACT OF TRAINING DENSITY ON PROSTATE CANCER DETECTION: AN ANALYSIS OF OVER 2000 PROSTATE BIOPSY CASES PERFORMED BY UROLOGY RESIDENTS

Abstract

INTRODUCTION AND OBJECTIVES: There is wide variability in the number of prostate biopsies performed by residents. Residency programs reported a vast range in number of cases per trainee in 2010 and 2011 (13-540, 17-329, respectively). This study investigates the impact of caseload density (number of biopsies completed over a given time period) on the likelihood of a positive biopsy result. METHODS: We examined 2,046 prostate biopsy procedures performed by first-year urology residents. Residents were divided into high-density (HD; first 10 cases in 15 days) and low-density (LD; first 10 cases in >15 days) training groups. The primary endpoint was the likelihood of cancer diagnosis. The frequency of cancer detection in the initial 10 cases was compared to that of the subsequent cases using generalized estimating equation models that account for correlated observations and control for multiple covariates. RESULTS: High-density training achieved significantly more consistent results compared to LD training. In the HD group, the odds ratios (OR) of detecting cancer ranged from 0.83 (p1⁄40.50) to 1.09 (p1⁄40.84) when comparing the first 10 cases with subsequent sets of 10 cases up to 50 cases (Figure). The cancer detection rate was unchanged comparing the first 50 cases with the subsequent 50-100 cases (OR1⁄41.40, p1⁄40.06) and >100 cases (OR1⁄41.17, p1⁄40.16). In contrast, LD residents showed significant and progressive improvement in their ability to detect prostate cancer during the first 50 procedures (OR up to 2.54, p1⁄40.018) before reaching a plateau at 41-50 cases. CONCLUSIONS: Training density may play an important role in medical and surgical residency education. For prostate biopsy, high-density training (first ten cases within 15 days) appears to result in more consistent cancer detection rate during subsequent procedures. We conclude that high-density training is likely to achieve earlier attainment of proficiency thereby obviating the need for large case numbers and allowing residents more time to master other procedures.